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Yh. N a. tJ fit4-2267 7 96, ?267j69 Emaih rths,eskntfrJhry,.uie.in ffiFrom

Civil SurgeonKarnal'

To

Mission Director, NHMpartytan Bhawan, Bays No. 55_58,Sector_2, panchku la, Haryan,

- -,

Leter No. NHM_ 1g/...&.j:..t...... Dated tUf.Af ry.subject: Regarding upload of rnform atio/ instructiono apprication formatNatiol11ill*flTii::ff. Hx;;")* i" ;;;;;;t"",,ur o,,

_tr,"

On the subject cited above.

It is requested to get uploaded theapplication format,urri uu.uncy positions under NHMNHM Haryana website. ao""iiJt*ent has been sentnewspapers today i.e ..........

information/ instructions,is District Kamal,on the

forn Rublication to ft:adingI

l. -/'1 . \rt14!',\c \tq

Civil Surgeon. Karnal

f,W,r,\oa\t1'| \\rr,

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DISTRICT HEALTH & FAMILY WELFARE SOCIETY, KARNAL

Applicationsareinvitedfrom.n.o.,#ffilecandidatestobeengagedonpurelycontract basis for the following posts in various NHM Programme under District Health ,& Familywelfare society' Karnal for the FY 2019-20, initially up to 3r't March 2020 ortill the completion ofthe project whichever is earlier' The application form complete in all respects along with requisitesigned documents should reach or be submitted in the office of civil Surgeon Karnal, Red crossBuilding,MallRoad,Karnal_13i00|,Haryanaonorpclsitively

CI'v'I'* SI liiililCN

CatNo. Name of Post

I\/6/.li^^lNro. of Posts

I r.reurLqr vrrrLsr LJr\r,uJ ulsrrlct Llvll Hospital , Karnal

-

Staff Nurse (SNC -

-

Account Assistant -Steff Nrr."o'c f rr -

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14 v L vruLrrLL Lrvrr rrurprLd.\ znx/ LHL s & pHC,sJ

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Urban Health Co

Staff Nurse tNBSU

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7

ll3

t2 hrlarlinol nFfi-^- rvrrreLr Lrrr\u., LvrsLtluL LIVII nospltal, Kafnalj

-

Bio Medicat Eng

Pharmacist tD

@anKarnal)ANIItt r'4,,..:t:^--- \r------ r.' r . -----::-

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nDIa I\t^- ^-^- rn: -!--l

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t7 s!rv IrqrrqSsr LUrJLtluL t,lvll fiospltau

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Audiologistr "n

-

Optometrist tD

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Frrn I\^^^+:^- ^^----

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20 rur Ll\rLI'J tulstnct Karnal_)L

2l j: surLrlue [ulsrrlct Llvu Hospltal, Karnal)1,

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K,,Lj \AL n.' crui:s*%r\i-r\,r* Karnd ,- %Tft,1'n\t't

Physiotherpi

StaffNurse,, INCOJ[1 District Civil Hosr sl.1!!q NrElas & r cuc rndri

seniorootspffi(Uistrict te Centre K;naD

SeniorTr"ut-ffiSenior tuOu.fDistrict TB Centre Karnal)

--r e'^'e'

Microbiologis@Psychiatric So.irt Wo.t* INMHP) (puq Kr."rD

Case Regist.y RssiGnt truvnp) (nnQ r<r.r,rt)wardAssistant[@

o For Application form & detailed information like essential qualifrication,renumeration' other criteria and instructions etc. visit district Karnalwebsite -

\qCivil SurgeonKarnal

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DISTRICT HEALTH AND FAMILY WELFARE SOCIETY, KAFINALAPPLICATION FORM

For office use

Receipt No.

Date

lm portant Instructions

. Please read instructions given in advertisement carefully before filling in each column.. Use only black/blue ball pen to fill the form.

Application for the post of1. Name of the candidate :

(ln Capital Letters)

Facility

2. Father's/Husband's Name :

(ln Capital Letters)

3. Sex: Male/Female

Affix llecentCoklred

Passport SizePhoto

4. Date of Birth :

(dd/mm/yyyy)

5. Category to which belong :

6. Telephone/Mobile No. :

7. E-mail :

8. Permanent Address :

Pin Code

9. Correspondence Address :

Pin Code

Educational/professional eualifications :

Month(s) Day(s)

ExaminationPassed

Board/University

Year ofPassing

MaximumMarks

MarksObtained

o/oQla

ofMarks

Division Subjects

l otn

10+21Vocational/Intermediate

Graduation

Post-Graduation

Any otherCourse/Diploma

etc.

Name of Institution/

11. Total Experience : year(s) Month(s)

Name of Institution/Organization

Details of Documents attached :

(Signature of the C;andidate)12. Declaration : I hereby declare that

1' All statemenl: T"9" in this application form are true, comprete and correct to thebest of my knowledge and belibi. ln the "u"nt

;i;t y information being found fatse orincorrect, or lneligibility being o"t".lJ 0"il'rJ"l,. after the interviewselection/

;iffIffiH,3"?1no'oature m1v oe canceite;r;iaction can be trr"n aglainst me

2' I have read the provisions/conditions/terms/rules in advertisement carefulty and Ihereby undertak.e to abide by them. I fulfil ail thl conditions. of eligibility regardingage limit' educational qualifiiations etc. prescribed in the advertisement and otherrelevant rules and instructions.

3. I have never been convicted by criminal court.

4. There is no court case pending against me.

Date:

Place:

(Signature of the Candidate)